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COLUMBUS, Ohio– The Ohio Department of Health says it confirmed three reports of severe pulmonary illness likely caused by vaping.

The patients ranged in age from 18 to 26, and are from Lucas, Richland and Union counties. All required hospitalization. The state is also investigating 11 other people with the illness, the department said in a news release on Wednesday.

On Aug. 23, the Ohio Department of Health issued an alert to health care providers to report suspected cases when the patient has a history of vaping.

The Centers for Disease Control said symptoms include couch, shortness of breath, chest pain, nausea, vomiting, fatigue and fever. Patients developed symptoms over days or months. According to the CDC, there are more than 200 possible cases across 25 states.

Government health officials recommend people stop using e-cigarettes during the investigation. The CDC also said people should not buy vaping products off the street or ones that have been modified.